News, insights and resources for parents of kids with autism spectrum disorders

Wednesday, June 27, 2007

Pennsylvania Governor Urges Passage of Autism Insurance Bill

Pennsylvania Gov. Edward G. Rendell today released a statement urging the General Assembly to pass a bill that would require health insurers to provide coverage for "proven medical treatments" for people with autism spectrum disorders up to age 21, with a cap of $36,000 per year. The bill, called Senate Bill 550, has already passed the state Senate but has not proceeded to a House vote.

"Pennsylvania has made great strides in our effort to 'Cover All Kids' with health insurance, but there is a large group of children for whom coverage is lacking due to a mistaken belief by insurance companies that autism is not a treatable medical condition," Rendell said. "By requiring private insurers to cover the medical services they should already be covering, we can make taxpayer dollars go further and help thousands of young people."

The language of the bill specifically calls on managed care providers to create a network of credentialed autism services providers; it also says that while the dollar cap holds at $36,000 per year, insurers may not limit the number of appointments per year a patient may attend.

What kinds of services can be covered? The exact details are to be worked out, according to the Senate-approved version of the bill. It states:

Treatment for autism spectrum disorders shall include the following care prescribed, provided or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or psychologist if the care is determined to be medically necessary: psychiatric care, psychological care, rehabilitative care, therapeutic care, pharmacy care; [and] any care, treatment, intervention, service or item for individuals with an autism spectrum disorder which is determined by the department of public welfare, based upon its review of best practices or evidence-based research, to be medically necessary and which is published in the Pennsylvania Bulletin.

The legislation goes on to say that any newly approved treatment must be covered within 120 days of the publication of these new rules.

Autism advocates in Pennsylvania held a rally on June 25 in support of another autism insurance bill, House Bill 1150, which also calls for covering autism services, with a similar cap of $3,000 per month. The bill was referred to a legislative insurance committee on April 30, according to the Assembly's website. (Read text of the House bill online here.)

The state Speaker of the House, who has a nephew with autism, has made bolstering autism services a key issue on his agenda. Parents and families and advocates have been rallying for it. And now the governor has weighed in.